Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

“…Studies show that 60-84% of patients undergoing gynecologic procedures still receive opioids for pain control, even after minor procedures, such as such as hysteroscopy, dilation and curettage, and bilateral tubal ligation [18][19][20]. A large analysis of over 132,000 women undergoing minor gynecologic procedures found that 1 in every 65 patients prescribed opioids for a gynecologic procedure develop a new persistent opioid use, independent of the type of opioid prescribed at first encounter [13]. Alarmingly, the highest risk factor for developing persistent opioid use was filling of the high-dose opioid prescription.…”

“…It is likely that the amount narcotics prescribed could be reduced further. As there is a wide range in the amount of opioids prescribed by obstetrics and gynecology specialists [13], the field would benefit from standardized guidelines to decrease the potential for opioid use and abuse across the general population. Further, setting patient expectations with respect to pain control, including the use of narcotic medication, as is done under the ERAS protocol, will have a positive impact on patient experience, without increasing the burden on the staff or clinicians with respect to phone calls or extra visits.…”

“…ERAS was pioneered in colorectal surgery but has been adopted by many other subspecialties [10], and recently applied to minimally invasive benign and oncologic gynecologic surgery [9,11,12]. Despite the widespread implementation of these programs, post-operative opioids for outpatient pain control are still over over-prescribed with the potential to further the opioid crisis [3,13].…”

Perioperative opioid-prescribing practices of resident trainees compared with staff surgeons

“…We performed a population-based cohort study using linked administrative data in Ontario, Canada, where all dispensed prescription opioids are recorded, regardless of insurance status. 1 We included opioid-naïve women (age !18 years) who underwent elective hysterectomy between January 1, 2013 and March 31, 2019 and filled at least 1 opioid prescription in the perioperative period (day of hysterectomy to 7 days after). We excluded emergency surgeries, patients with malignancy, history of opioid toxicity, those who received opioids in the previous a The trainee referent group weights differ for the 2 pairwise comparisons.…”

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

“…8 Importantly, one in every 65 patients who initiate opioids after gynecologic surgery will experience prolonged use. 9 However, interventions to reduce opioid diversion through patient education have a positive effect. 10,11 Institution-based Enhanced Recovery After Surgery (ERAS) opioid-prescribing recommendations also result in reduced opioid overprescribing.…”